Your doctor’s job is to make sure
that you are prescribed the most cost-effective drug. A drug
rep’s job is to
sell his or her product, whether or not this product is in
fact the most cost-effective. Not surprisingly, information
provided by reps is likely to biased in favor of their product.
Furthermore, reps often provide gifts—food, pens, pads,
and more food—in hopes of influencing what your doctor
prescribes. Again, not surprisingly, research (as well as
common sense) suggests that this works: Doctors who meet
with reps and accept gifts from drug companies are more likely
to prescribe their drugs – and this may mean a more
expensive and possibly even inappropriate drug. There are
plenty of sources of information available to doctors—non-promotional,
unbiased, independent sources of information, so there is
no longer any need for doctors to rely on sales people for
this information. Unfortunately, these sources don't come
with free lunch!

Samples

Many doctors provide samples to patients who lack prescription
drug coverage or out of convenience. In fact, many doctors
will say that obtaining samples is the primary reason they
see reps. Drug companies spend ½ their promotional
dollar (more than 10 billion dollars in 2002) on these samples.
And for good reason: Samples are an extremely effective marketing “tool.” Samples
get patients, and doctors, “hooked” on the sampled
drug. But, not surprisingly, the “Sample Closet” is
filled with the newest, most expensive medications, in brightly
colored promotional packaging reminiscent of the supermarket
cereal aisle. Though receiving a sample from your doctor
may often seem convenient (and may also save you money in
the short run), it may also result in you ending up on the
wrong medication, and in the end costing you even more money,
and maybe even worse. “COX-2 inhibitors” like
Vioxx were heavily “sampled,” and given out to
patients who didn’t need them, when older, cheaper
drugs were available. Vioxx, of course, was later found to
have adverse effects on the heart. Furthermore,
many practices do not keep proper track of which samples are
given to whom; this could create a problem if a drug (or
lot) were recalled. There are alternative, and preferable,
ways to obtain medications--use of patient assistance programs,
for example, as well as using generics whenever possible (see below).

Generics

New drugs are developed under patent protection, which gives
the manufacturer the sole right to market their drug. When
the patent expires, companies may introduce generic formulations.
According to the FDA “A generic drug is identical,
or bioequivalent to a brand name drug in dosage form, safety,
strength, route of administration, quality, performance characteristics
and intended use.” However, generics cost less, often substantially
less than name brand products. Many insurers require prescriptions
for generics when these are available. Though some patients
prefer “name brand,” cost is really the only
difference between the generic and the name brand product.

Despite the availability of identical, but cheaper, alternatives,
patients are often nevertheless prescribed branded drugs.
There are several reasons for this:

1) The name brand products are promoted to doctors, generics
are not.

2) Name brand products are promoted to patients, generics
are not.

3) The samples found in your doctor’s “sample
cabinet” are name brand products, not generics (see
above). Patients are often started on samples (as a trial,
out of convenience, or for financial reasons). When a prescription
is ultimately written, it is more likely to be for the sampled
drug.

No, but while it is no doubt true that many doctors, despite
walls adorned with Claritin clocks and Cozaar calendars,
practice very good medicine, studies have shown that doctors
who meet with and accept gifts from reps are more likely to prescribe
expensive, perhaps inappropriate medications. While
it is true that doctors are very busy, and there’s
lots of new information coming out every day, there are also
lots of sources of drug information available to doctors
that are likely to be less biased then information provided
to them by sales people.

How do I know if my doctor is an addict?

It's not too difficult to tell how much time your doctor
is spending with sales reps. For one, there will usually
be several of them in the office at any given time--often
being called before you, especially if it’s around
lunchtime. Branded clocks, note pads, facial tissue boxes,
and of course pens, are a giveaway. The size of the "sample
cabinet" is generally directly proportional to the number
of reps that your doctor sees.

What can I do?

As a patient, you have potentially a lot of power. However,
given the nature of the patient-physician relationship, it
is often difficult for most patients to confront their doctor
about this issue. (Asking, for example, “why are you
writing me a prescription for Nexium, using a Nexium pen,
when omeprazole would do just as well and is much cheaper?”).
If you feel able to do this, by all means, just do it! Some additional ideas:

Leave behind a No Free Lunch pen on your doctor’s
desk (perhaps "exchange" it for that Nexium pen)

Leave behind some No Free Lunch “Doctor Information
Materials.”

How do I find a non-drug company-addicted doctor?

Several hundred health care providers have taken the No Free Lunch Pledge, pledging to
accept no gifts from drug reps and practice medicine on the
basis of scientific, rather than promotional, literature.
The listing of these doctors will soon be posted on this
website, so you will be able to choose a “drug company
free M.D. or a "Say No D.O.” We anticipate that in the not so distant
future “No Free Lunch Certified” will be as prestigious
as “Board Certified” as an indicator of quality.

Public Citizen's Worst Pills, Best Pills News, published
since 1995, is a member of the International Society of Drug Bulletins and a web based version is now available at www.worstpills.org.
The newsletter is written for patients and focuses on risk, safety and new drug evaluations.